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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We presented a case of critical illness polyneuropathy after bacterial peritonitis. A 62-year-old male was received an emergency colectomy because of perforation of the sigmoid colon five days after the endoscopic polypectomy. He developed sepsis from peritonitis after operation in spite of the antibiotics therapy. On 15-th hospital days he developed muscle weakness and numbness of all limbs. He needed an artificial ventilator due to respiratory failure. Hematological and blood chemical findings showed a leukocytosis and metabolic acidosis with renal dysfunction because of sepsis. Serum anti-Campylobacter antibody was negative. Serial CSF examinations failed to show any abnormalities including albuminocytologic dissociation. Electrophysiological studies revealed a primary axonal degeneration, mainly in the motor, but also in the sensory nerve. Compound muscle and sensory action potentials were not elicited or markedly reduced without conduction velocity prolongation. Microscopic findings of the left sural nerve biopsy showed a primary axonal degeneration without evidence of inflammation. His prognosis was poor and three months later, he still required ventilatory assistance. Because of these clinical findings this patient was thought to have a critical illness polyneuropathy after excluding various etiologies of polyneuropathies. This case suggests that sepsis may be one of a cause of primary axonal polyneuropathy. The certain mechanism of this disease is still unknown. However cytokine, tumor necrotic factor(TNF) and/or Platelet activating factor(PAF) that secreted during sepsis may have an important role for the primary axonal degeneration.
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PMID:[A case of critical illness polyneuropathy in association with peritonitis after sigmoid colon perforation]. 766 19

We describe a 41-year-old patient with adult-onset dermatomyositis who developed persistent pneumomediastinum and severe subcutaneous emphysema due to end-stage interstitial lung disease. The diagnosis of dermatomyositis was based on proximal muscle weakness, electromyographic findings of inflammatory myopathy, and positive findings on muscle biopsy. Low levels of creatine kinase elevation were found at the time of diagnosis (a form of dermatomyositis which has been associated with a poor prognosis). The patient had no signs of cutaneous vasculitis. Despite treatment with prednisone and azathioprine, she died of intercurrent gram-negative sepsis 15 months after the diagnosis of dermatomyositis.
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PMID:Chronic pneumomediastinum and subcutaneous emphysema: association with dermatomyositis. 771 58

The initial diagnoses of associated injuries in patients with traumatic brain injury (TBI) are often overlooked because of the priority given to life-sustaining measures. Pelvic and abdominal injuries comprise less than 5% each of the concurrent injuries associated with TBI and multiple trauma. This report describes a 32-year-old man who sustained a moderate TBI with facial, pelvic, and extremity fractures secondary to a fall. His hospital course was complicated by sepsis, acute renal failure, and retroperitoneal hemorrhage. Admitted to the rehabilitation service 6 weeks after the fall, the patient was found to have a previously undiagnosed profound quadriceps muscle weakness. A diagnosis of femoral neuropathy was confirmed by electrodiagnostic studies and was attributed to compression by pelvic hematomas. Rehabilitation management included use of a solid ankle cushion heel (SACH) wedge, a functional knee brace, a progressive ambulation program, neuromuscular stimulation, and patient and family education with an emphasis on safety. The patient progressed rapidly with his rehabilitation program, improving from moderate assistance in all skills to independence in 3 weeks. This case illustrates the importance of the physiatrist's role in the early detection of associated injuries in patients with multiple trauma and TBI; it also illustrates some of the rehabilitation techniques that may be employed to aid a patient with a femoral neuropathy to regain junctional ability.
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PMID:The rehabilitative management of the traumatic brain injury patient with associated femoral neuropathy. 774 23

With increasing survival rates from acute medical or surgical emergencies a new form of peripheral neuropathy, CIP, has been recognized. CIP can be seen only in patients who are considered to be critically ill; therefore, it invariably occurs in the ICU. Typically, initial symptoms begin with transient (hours to a few days) septic encephalopathy followed by generalized weakness, manifested in weaning failure, limb weakness and hyporeflexia. Diagnosis is confirmed by an EMG. CIP should be considered in any elderly patient with sepsis and prolonged respiratory muscle weakness. Prognosis is poor in severe cases, in which the EMG also shows severe axonal degeneration. In milder forms, fair to good recovery is expected within weeks. Management includes treatment of sepsis, normalization of failing organ function, physical therapy and proper nutrition.
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PMID:Acquired respiratory failure in critically ill patients. 786 Sep 77

We report a 54-year-old man with progressive generalized muscle atrophy and ophthalmoparesis in the terminal stage. He was well until 44 years of age (1982) when he noted weakness in his right hand and muscle atrophy; in May of 1985, he noted weakness in his left hand and in both legs. His weakness had become progressively worse, and he became unable to walk in November of 1985. He noted dysarthria one month later, and dysphagia in March of 1986. His difficulty in swallowing had also become worse; he regurgitated foods into the trachea in September of that year, and he developed a low grade fever on the same day. He was admitted to our service on September 24, 1987. On physical examination, general findings were unremarkable, except for low grade fever (37.3 degrees C). On neurologic examination, he was alert and mentally sound. He had normal vision and visual fields; ocular movements were normal. He had moderate weakness in facial muscles, dysarthria, dysphagia, and atrophy in his tongue. He had marked generalized muscle atrophy with fasciculation. He was unable to stand or walk. His muscle strength was not more than 1/6 in any part. The lower extremities were spastic. Deep reflexes were exaggerated in both lower extremities but were normal in upper extremities. Sensation was intact. Laboratory examination was unremarkable, and so was the cranial CT scan. He was treated with nasogastric feeding. He was able to communicate smoothly using his eyes, but a restriction in the vertical gaze was noted in February of 1989. The range of ocular movement was better in the oculocephalic reflex compared with his spontaneous vertical eye movements. In April of 1990, his horizontal gaze also had become slow, and he was complicated by bronchial asthma. He was treated with 20 mg/day of prednisolone; after the institution of prednisolone, his horizontal eye movement showed much improvement. In the terminal stage, he was able to move his eyes only very slowly; vertical gaze was impossible. His subsequent course was complicated by respiratory tract infection and septicemia, and he expired on July 15, 1992. The patient was discussed in a neurological CPC, and the chief discussant arrived at the conclusion that this patient had amyotrophic lateral sclerosis with oculomotor paresis. Post-mortem examination revealed spongy change involving the posterior column and the posterior spinocerebellar tract, in addition to severe degenerative change in the upper and the lower motoneurons, which were consistent with amyotrophic lateral sclerosis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[A 54-year-old man with generalized muscle atrophy and oculomotor paresis]. 799 50

This study was performed to determine the optimum dose of pancuronium (n = 30) and pipecuronium (n = 30) under continuous sedation and analgesia in the intensive care unit (ICU). This was an open clinical investigation in 60 critically ill patients with head injury, multiple trauma (in some complicated with sepsis and multi-organ failure), requiring neuromuscular block for ventilation for at least 48 h. Emphasis was placed on the neuromuscular monitoring with a peripheral nerve stimulator and adequate sedation and analgesia. Satisfactory block was achieved in all cases with an average dose of 3 mg/h with either compound. None of the patients experienced prolonged paralysis, muscle weakness, or other neuromuscular dysfunctions in the postventilatory period. We suggest that adequate use of sedative hypnotics and opioids plus neuromuscular monitoring allowed us to optimize the dose of muscle relaxants according to the need of individual patients.
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PMID:Long-term administration of pancuronium and pipecuronium in the intensive care unit. 786 54

The peak time period for the average beef producer to experience the majority of calf losses has consistently been from the time of birth through the first seven days of life. Weakness is a principal clinical sign of diseases or conditions responsible for mortality including birth trauma, prematurity or dysmaturity, congenital malformations, metabolic defects, intrauterine infection, anoxia or hypoxia, hypothermia, starvation, extremes in birth weight, and post-natal infection. This article discusses anoxia/hypoxia and septicemia in greater detail because of their involvement as a common cause of weakness in the newborn calf.
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PMID:Weakness in the newborn calf. 819 20

Four septic patients and one asthmatic patient are described who developed a severe paralytic disorder in an intensive care unit (ICU), associated with a rise in serum creatine kinase and a severe necrotizing myopathy. All cases had received non-depolarizing muscle blocking agents and large intravenous doses of glucocorticoids. Three patients developed myoglobinuria. No improvement or very little improvement in muscle function was noted in the four fatal cases. The single survivor recovered his strength after 6 months. This syndrome ("necrotizing myopathy of intensive care") provides one of the differential diagnoses for ICU-acquired weakness. The myopathy appears to have several interdependent causes and it is proposed that these should be classified as myonecrosis "priming" factors (glucocorticoids, myotropic infections, sepsis) and "triggering" factors (non-depolarizing muscle blocking agents).
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PMID:A syndrome of acute severe muscle necrosis in intensive care unit patients. 835 28

We report a 70-year-old man who had a sudden onset of right hemiparesis and mutism. The lower extremity was more involved than the upper one. He had a long history of diabetes and chronic renal failure for which hemodialysis was necessary. On August 30, 1990, he had an sudden onset of right hemiparesis and mutism. Neurological examination revealed awake but mute in no acute distress. He could only respond to very simple commands such as opening his mouth or protruding his tongue. He did not appear to understand more difficult questions. In addition, he could not answer verbally. He was totally mute. Cranial nerves appeared intact except for slight right central facial paresis and severe diabetic retinopathy. He had complete paralysis of his right leg and a moderate weakness in his right upper extremity. Deep reflexes were diminished in both upper extremities and absent in the lower limbs. Frotal signs such as grasp and snout reflexes were present. Cranial CT scans revealed an ill-defined low density area in the left parasagittal subcortical area and a part of the anterior cerebral artery territory. The supplementary motor area appeared at least in part to be involved. He was treated with glycerol and other supportive cares, however, his clinical course was complicated by pneumonia, heart failure, septicemia, and he expired two months after his stroke. The patient was discussed in a neurological CPC, and the chief discussant arrived at a conclusion that he had an artery-to-artery embolism at the internal carotid bifurcation resulting in the cerebral infarction mainly in the territory of the anterior cerebral artery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A 70-year-old man with right hemiparesis and mutism]. 836 54

Sri Lanka's health policy calls for health services to be accessible to all people, which requires appropriate training of physicians, nurses, and paramedicals. Increasing the training and cadre of public health midwives allows Sri Lanka to make free domiciliary and field health services available to all parts of the country. Sri Lanka must adopt realistic measures to improve guidance and supervision of midwives to derive maximum benefits. Sri Lanka first instituted primary health care (PHC) in 1926 (Health Unit at Kalutara). PHC provides 3 stages of maternal and child health care through home and/or clinic visits: prenatal care, trained assistance during delivery, and postpartum care. In most parts of Sri Lanka, 1 family health worker is available for every 3000 people. Yet, maternal mortality is rather high. A UNICEF study shows that family health workers register only about 50% of pregnant women. A lack of personnel to provide maternal health services is a main reason for high maternal mortality. Many medical officers (1979, 52%) have not done an internship in gynecology and obstetrics. Many (1979, 38%) are assigned to peripheral facilities where they practice obstetrics without any help from experienced physicians. They are reluctant to do simple obstetric measures, e.g., removal of a retained placenta. This reluctance keeps some physicians from admitting mothers in labor, so they transfer them to upper-level hospitals. The Postgraduate Institute of Medicine needs to implement courses in obstetrics and gynecology so the district hospitals can have competent obstetricians on staff. The leading causes of maternal death are, in order of frequency, hemorrhage, abortion complications, eclampsia, sepsis, and obstructed labor. Anemia and retained placenta are the reasons for hemorrhage. Insufficient access to life-saving treatment in emergencies is the single most critical weakness in the maternal health care system, indicating a need to establish intensive care units.
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PMID:Changing trends in maternity care in Sri Lanka. 837 90


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